SENIOR Q&A: Understanding Alzheimer's disease

Thursday

Q: My mother has Alzheimer’s and I have noticed that she is eating less, more tired, and generally looking like the disease is progressing. Can you explain to me the last phase of the disease?

A: The last phase of Alzheimer’s disease is often when someone is eating less and losing weight along with difficulty swallowing. Many times the diet is changed to pureed and thickened liquids and they need to be fed. Your mother may stare more and not be able to respond to you or others. Everyone progresses through the stages differently. Often at this stage there is another review of options such as feeding tubes and life supports to make sure your mother’s wishes are being honored. Often, hearing is the last to go and even if your mother is unable to respond to you she hears your voice.

Q: My father has a long-term care policy. When is the best time to put it into effect? Is it better to wait until he is in a facility or use the policy starting now for help in the house?

A: Good question and a difficult one to answer. It is important to read the policy and to have an Elder Law Attorney read the policy to best understand what is covered and for how long. Some policies have a cap of money that they pay out and some policies pay for help in the house and then still pay for long-term care. Some policies have a lifetime payment and others only pay for a certain number of years. This is why you need to have an expert read the policy to explain the benefits. Then you can decide the best time to put the policy in effect. Also many policies are written that once payment for care is started, the monthly premium no longer needs to be paid.

Q: My father is in an assisted living facility and within the next year his money will be running out. He is social and content. I do not want to tell him that he will be moving. How do I break the news to my father and what options are available to him? How do I find a good next place?

A: Some assisted livings homes offer low-income or tax credit options. Some facilities have contracts with the Medicaid program. We have seen some facilities that will reduce the rent in order to have someone stay at their facility. Talk with the staff letting them know money will be running out and do they offer any programs or a reduced rent to allow your father to stay in his home. If that is not available then you need to begin your search for where your father can move.

Many people move from an assisted living to a medical setting/nursing Home. Nursing homes have contracts with Medicaid, allowing your father to live in the facility and have his costs paid for by Medicaid. Begin the search when your father has about seven to eight months of private funds for a medical setting. The medical setting is often higher in cost. This allows your father to have options of facilities. Talk with an elder law attorney before filling out the financial application.

When looking at facilities to determine which one is a good fit for your father, begin by consulting with a geriatric care manager or aging life care professional. An assessment will be completed on your father and a meeting with family to discuss options, questions to ask when touring a nursing home, etc. If your father is able to understand what is happening, begin your search and when you find a good facility sit down and talk with your father. You know your father best and if you think he wants to be part of the planning, allow him to take a tour of one or two facilities after you have toured. If your father has memory loss then do not give too much notice and limit information. Our philosophy is to give information that your father can understand but not too much to worry him whether he has dementia or not. This is where the geriatric care manager can help.

Debbie Gitner, LCSW, C-SWCM, is past president of the New England Chapter of Geriatric Care Managers/now called Aging Life Care Association. Linda Sullivan, R.N., C.M.C., is a registered nurse and certified Geriatric Care Manager. Together they are owners of ElderCare Resource Services in Marlborough and Framingham, helping families to provide best options, advocacy, assistance, and resources for families as they navigate this complicated medical maze. Contact them at 508-879-7008; or visit info@eldercareresourceservices.com.